Complex Denials, Accounts Receivable 2

Job Description:

• Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
• Update patient demographics/insurance information in appropriate systems
• Research/Status unpaid or denied claims
• Monitor claims for missing information, authorization and control numbers(ICN//DCN)
• Research EOBs for payments or adjustments to resolve claim
• Contacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission
• Access client systems for payment, patient, claim and data info
• Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
• Secure needed medical documentation required or requested by third party insurance carriers
• Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
• Perform other related duties as required

Requirements:

• 2-3 years of medical collections, complex denials and appeals experience
• Experience with all but not limited to the following denials- DRG downgrades, level of care, coding, medical necessity
• Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
• Intermediate knowledge of third party billing guidelines
• Intermediate knowledge of billing claim forms(UB04/1500)
• Intermediate knowledge of payor contracts- commercial and government
• Intermediate Working Knowledge of Microsoft Word and Excel
• Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

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